The process goes something like this. My brain -- plus everyone I know -- tells me: "Josh, never in 29 years of living have you displayed the slightest aptitude, interest, passion for, or knowledge of the field of medicine." True. And I have not exactly gained any of those things either, since this perverse fancy suddenly blossomed within me last year. So why does it appeal?
It is precisely because it is nearly impossible -- but not quite. It is highly unlikely that a 29 year-old might change course and suddenly excel at a field and profession they never cared about before -- but it could happen. It has therefore become for me the ultimate emotional symbol of recapturing one's fleeting youth. Of reversing the hand of time. Of blotting out the writ of Khayyam's moving finger. You see! I cry. It is not too late! I can still start over from the very beginning.
I mentioned in my previous post that a particularly devouring flare-up of this fantasy occurred over the weekend. I had met someone tremendously gifted and successful in the fields of music, science, and mathematics. And as always happens, any other areas of life in which I may be skilled suddenly seemed to be unimportant and unimpressive by comparison.
Clearly, there was only one solution: become a doctor.
"But Josh" -- my brain cuts in again -- "don't you care more about literature and human rights than you do about medicine?" Yes, but I would be such a literary and human rights-y sort of doctor, I plead in response. I'd be like Sir Thomas Browne! (Not that I've read him, but becoming a doctor would give me a fine incentive to do so.) I'd be like Albert Schweitzer! Or Paul Farmer!...
Seeking, after these reflections, the distinct kind of consolation that can only come from deliberately sinking oneself deeper into sadness, I turned (as mentioned last time) to Saul Bellow's brief novel Seize the Day. I felt an ache in my stomach and a throb in my heart as I read it that did not abate until I had reached the end of this short book. Here, described so pithily, was exactly my predicament. Time wasted. Life pathways set and irreversible. Destinies fixed and unchanging.
So what if I'm actually doing okay, overall? It still seems tremendously unfair that I never get to do it all again. That I only get the chance to be one person, and to be good at one narrow band of things, rather than being able to take pass after pass at life and perfect myself in every dimension.
For the protagonist of Bellow's novel too, it is medicine that serves as the reminder of the course he did not take -- the life opportunities he chose not to act upon. Throughout his life, Tommy Wilhelm spurned courses of action because they were ones his father had taken, or were pressed upon him by his family. Only to find in middle age that those were precisely the things he should have done.
Wilhelm recalls in one scene that his mother had advised him once that he would have an easy and straight shot at a medical career if he chose to go that route. Why didn't he? "To remember this [interchange] stifled him," writes Bellow. In another he notes that Wilhelm refused to study chemistry because his father had already done it.
Science, medicine, math, music. Like Tommy, I am left thinking - why didn't I put my head down and devote myself to cracking all of these particularly tough nuts? Where would I be now if I had done so? Could I too be an opera singer with a PhD in Applied Math and a job at a cancer treatment center, like the person I met over the weekend? And why does it fail to console me to know that that person might very well be envying as we speak the life of an employee at a human rights organization, and wishing to swap places?
In spite of one's reason and rationalizations, it's still hard to escape the feeling that some people have all the luck. As Tommy Wilhelm observes, of a quack doctor he half-admires and half-doubts, "He had everything it was possible for a man to have -- science, Greek, chemistry[.]"
Ah, chemistry! My worse subject in high school! Can it be that this is precisely why it is now you to which my guilty conscience strangely turns, as I approach my thirtieth year? And is it precisely because it would require so much chemistry that the pre-med path now beckons to me as the one challenge that is worthy of my fourth decade on Earth?
And isn't all this the right -- the celebrated -- approach to life? Shouldn't I seek out new and bigger challenges, in this way? Should I not retrace my steps and confront the obstacles that slowed me down in the past? Is this not the essence of self-improvement? Is this not what being an American is all about? If at first you don't succeed, try, try again?
--
Still in this mood, I remembered and started playing a podcast that a friend had earlier recommended to me. He had told me that it was a true crime podcast, but you "also learn something about medicine along the way." I was intrigued and popped it on.
It is called Dr. Death -- you may have heard of it. And it turns out that if anything can serve to dampen a burning doctor fantasy, it is this show.
This six-part documentary charts the horrifying true story of a doctor in Dallas, TX -- my home burg -- who manages to hold down a practice as an eminent neurosurgeon, with an MD/PhD and glowing academic and professional references -- all while savagely maiming or killing nearly ever patient who comes under his scalpel.
The doctor's operations are so profoundly mangled that the podcast creators -- and other observers -- are ultimately at a loss to point to any one cause that could have motivated the doctor to act in this way, or that prevented the system from stopping him before he irrevocably harmed more than 30 people.
By the show's end, we are all agnostic as to whether Dr. Death himself was a sociopathic killer, a narcissist and pathological liar deluded as to his own skill at surgery, or someone impaired by mental illness, chronic drug use, or prior brain damage -- or some combination thereof. What is clear is that he continued to practice medicine long after he should have been stopped.
There are many things that make this show utterly riveting, from episode 1 to the end. The first is the simple fact of its nightmarish quality -- its confirmation of our worst fears. Physicians throughout history have been endowed with unique power, prestige, and privilege. We allow them a degree of intimacy, a capacity to invade our bodies and even inflict forms of violence and bodily harm for the greater good of the organism, that we grant to no one else.
The thought of being subject to abuses of this power -- without recourse -- is something we think should not be possible in a free society. We no longer believe that professional education and privilege confer upon any group of people the right to invade our bodily autonomy without consent -- especially when doing so will harm us, apparently intentionally.
The fact that someone could continue to do so to so many innocent people seems reminiscent of the bad old days of medicine. Before the modern reforms that presumably exorcised the demon of the quack physician and the fake surgeon.
The literary incidents that came to mind for me in hearing about the career of Dr. Death, after all, are very much a product of that pre-reform era. I was reminded of the indelible scene in A.J. Cronin's The Citadel in which our general practitioner hero conducts a surgery with a colleague, who turns out to be a total fraud and bungler, and whose actions in the O.R. lead to the patient's death.
The podcast called to mind as well that haunting scene in George Crabbe's The Village, in which he describes the life of the elderly poor in a workhouse in rural England, and the fate they suffer at the hands of visiting physicians. As Crabbe describes the doctor who afflicts them:
A potent quack, long vers'd in human ills,
Who first insults the victim whom he kills;
Whose murd'rous hand a drowsy bench protect,
And whose most tender mercy is neglect.
But why, the question must arise, was the bench so "drowsy" in the modern United States? Why did the courts not take this man's license, and why did his former patients not put him out of business through lawsuits? My first question to the friend who recommended the podcast was: why wouldn't this guy be instantly put out of commission by malpractice claims, after just the first few botched surgeries?
As the podcast makes clear -- and as my friend explained -- we have tort reform to blame. Texas in recent decades has served as a laboratory for the reforms of medical malpractice law that the GOP has periodically sought to implement across the United States.
You may recall George W. Bush, for one, gunning for this during his presidency. This is what led to his famously and characteristically mangled utterance about too many "good docs" no longer being able to "practice their love with women" due to malpractice suits.
This was also what led to an exchange in my high school that permanently cemented my despair over my classmates and the Republican Party. A fellow student said to me, "My family supports Bush because my dad's a doctor and he says Bush will save him money."
There was so much about this that outraged me. I could not stand the idea that this classmate of mine apparently felt no need to cover her selfish political calculus with even a fig-leaf of phony idealism. I couldn't stand the thought that someone's father was willing to frankly state that their political decision-making as a family was motivated by not even a pretense of the public good, but simply and purely because of economic self-interest. And that he would pass this on to his own children!
At any rate, though, my classmate's father was not unique. Doctors throughout the country are excited about tort reform because it will lower their malpractice insurance premiums -- through capping the amount of damages they would conceivably have to pay out if they were uninsured. The Republican party supports tort reform in turn. In part this is just because it is a way to deliver financially for a powerful and well-heeled GOP constituency, who can then be relied on for future donations.
As George Lakoff once pointed out, however, tort reform has been a "strategic initiative" for Republicans for a deeper reason as well. It cuts off a major revenue stream for consumer protection attorneys, who tend to vote Democratic and contribute financially to the Democratic party. The GOP accomplishes two goals in one, therefore -- keeping doctors happy, which slashing local Democratic fundraising efforts.
This policy comes at a huge cost for the general public, however -- as Dr. Death makes clear. When malpractice claims are capped and standards are tightened to render many of these suits effectively unworkable, it removes one of our democracy's critical safeguards on the prerogatives of physicians - people who are otherwise granted enormous power in our society over life and limb.
This is a large part of what accounts for that "drowsy bench" in Texas that failed for so long to stop Dr. Death.
There's something else, however, that makes this podcast particularly fascinating and resonant. It's the fact that it offers a dark twist on one of our most beloved legends as a nation.
All of us grew up with the admonition to never give up. To try, try again. We were all exposed in school to the story of the little engine that could.
And Dr. Death, it turns out, is someone who embodies that ideal to a T. He never gave up. Despite mountainous evidence that he was utterly ill-equipped to be a surgeon. Despite failing crudely at every surgery he ever attempted. He still kept at it. Dealing untold damage to innocent people in the process.
A childhood friend of the doctor is quoted at one point in the series. He observes the strange tragedy of this tale and the poignant sense of disenchantment it holds for any American raised on the national virtues. He notes how he used to describe his doctor friend's persistence as an example for his children to follow. "All the time I knew him he never gave up, he kept at things until he could get them right," he says. He then adds bitterly: "This wasn't how that story was supposed to end up."
Of course, a big part of my own doctor fantasy -- as made clear above -- is rooted in this same national mythology. I am convinced deep down that I ought to be applying myself to all the things that are hardest for me, for the sake of being "successful." I ought to be chugging up the hill, saying to myself "I think I can, I think I can."
To understand why this can actually be a source of destruction, rather than self-improvement, we perhaps need a more ancient fable than the little engine that could. If we turn to Aesop, we find that the wisdom he has to impart was quite different -- to the contrary of the little engine, in fact. Rather than keep at it, no matter what, he counsels, be true to oneself. Cultivate and be grateful for your own gifts, rather than seeking after everyone else's.
Many of his fables convey this lesson. Perhaps the most famous of these (as it accounts for the name of that Sean O'Casey play that had otherwise been inscrutable to me) is that of Juno and the Peacock. The peacock approaches the goddess in a venomous mood. She asks what is the good of having such lovely feathers, if she will never be so good at singing as the nightingale? Juno scolds her, saying that each should be grateful for the gifts they have received, rather than envying those of others.
There is of course something enormously peacock-like about my doctor fantasy. It was even a singer in my case -- in the example from this weekend -- that first cast me into doubt about my whole life- and career-trajectory. That was my nightingale, I fear.
Dr. Death reminds us that it may in fact be best for oneself and the people around you to heed Juno's words, rather than to keep chugging. Do not try to be something you are not (indeed, many fables in the Aesopic corpus also warn against quack doctors and medical imposters). Be true to your own capacity and calling, rather than what you imagine may count for prestige in other's eyes. Or, as Oscar Wilde once put it, referring to the temple at Delphi: "'Know Thyself' was written over the portal of the antique world. Over the portal of the new world, 'Be Thyself' shall be written."
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